Virtual Care Team Guided Management of Patients With Heart Failure During Hospitalization.

Background: Scalable and safe approaches for heart failure guideline-directed medical therapy (GDMT) optimization are needed.

Objectives: The authors assessed the safety and effectiveness of a virtual care team guided strategy on GDMT optimization in hospitalized patients with heart failure with reduced ejection fraction (HFrEF).

Methods: In a multicenter implementation trial, we allocated 252 hospital encounters in patients with left ventricular ejection fraction ≤40% to a virtual care team guided strategy (107 encounters among 83 patients) or usual care (145 encounters among 115 patients) across 3 centers in an integrated health system.

Under the ACA Higher Deductibles and Medical Debt Cause Those Most Vulnerable to Defer Needed Care.

Objective: Study occurrence and consequences of deductibles and medical debt among privately insured under the Affordable Care Act.

Methods: Analysis of 2012-2016 National Health Interview Survey data on privately insured adults younger than age 65 on the effect of deductibles on medical debt, deferred medical care, and office visits, by demographic characteristics, and treatable chronic diseases.

Results: Rates of medical debt and deferred care decreased.

Privately insured adults in HDHP with higher deductibles reduce rates of primary care and preventive services.

Rates of insurance coverage in high deductible health plans (HDHP) and deductible size have been increasing. Over-time, financial barriers can lead to a substantial reduction in opportunities for health promotion and care coordination. We investigated the impact of different types of HDHPs on primary and specialty services utilization and receipt of preventive services among adult (18-64 years) privately insured respondents using pooled 2011-2014 Medical Expenditure Panel Survey (MEPS).

Among Low-Income Respondents With Diabetes, High-Deductible Versus No-Deductible Insurance Sharply Reduces Medical Service Use.

Objective: To contrast the effect of private insurance and deductibles (by size) on medical service use, health status, and medical debt for adult respondents with diabetes with low and high incomes.

Research Design And Methods: Using the 2011-2013 Medical Expenditure Panel Survey, bivariate and regression analyses were conducted to compare demographic characteristics, medical service use, diabetes care, and health status among privately insured adult respondents with diabetes, aged 18-64 years (N = 1,461) by lower (<200% of the federal poverty level) and higher (≥200% of the federal poverty level) income and deductible vs. no deductible (ND), low deductible ($1,000/$2,400) (LD), and high deductible (>$1,000/$2,400) (HD).

The impact of insurance and a usual source of care on emergency department use in the United States.

Background. Finding a usual source of care (USC) is difficult for certain populations. This analysis determines how insurance type and having a USC affect the settings in which patients seek care.

Projecting US primary care physician workforce needs: 2010-2025.

Purpose: We sought to project the number of primary care physicians required to meet US health care utilization needs through 2025 after passage of the Affordable Care Act.

Methods: In this projection of workforce needs, we used the Medical Expenditure Panel Survey to calculate the use of office-based primary care in 2008. We used US Census Bureau projections to account for demographic changes and the American Medical Association's Masterfile to calculate the number of primary care physicians and determine the number of visits per physician.

Comparison of sarcoidosis phenotypes among affected African-American siblings.

Study Objective: To test the hypothesis that sibling pairs, who share genes and environmental exposures, might have similar phenotypic expressions of sarcoidosis beyond what would be expected by chance alone.

Design: Multicenter family study with study subjects recruited from 11 clinical centers.

Subjects: Subjects were African-American sibling pairs with sarcoidosis.

Pulmonary and psychosocial findings at enrollment in the ACCESS study.

Aim: To assess lung involvement and the association of demographic and psychosocial factors with respiratory health in 736 persons with sarcoidosis at enrollment in A Case Control Etiologic Study of Sarcoidosis (ACCESS).

Methods: 736 patients with biopsy diagnosis of sarcoidosis within 6 months of enrollment were studied at 10 US centers. Lung involvement was evaluated by chest radiography, spirometry and dyspnea questionnaire.

A sarcoidosis genetic linkage consortium: the sarcoidosis genetic analysis (SAGA) study.

Background: Sarcoidosis, a systemic granulomatous disease of unknown etiology, likely results from an environmental insult in a genetically susceptible host. In the United States of America, African Americans have a higher sarcoidosis incidence and suffer greater morbidity than Caucasians.

Methods: A sarcoidosis genetic linkage study consortium was established to recruit African-American affected sib pair (ASP) families to identify chromosomal regions that may harbor sarcoidosis susceptibility genes and to determine if environmental factors modify any genetic effects.

Job and industry classifications associated with sarcoidosis in A Case-Control Etiologic Study of Sarcoidosis (ACCESS).

Objectives: To determine whether specific occupations and industries may be associated with sarcoidosis.

Methods: A Case Control Etiologic Study of Sarcoidosis (ACCESS) obtained occupational and environmental histories on 706 newly diagnosed sarcoidosis cases and matched controls. We used Standard Industrial Classification (SIC) and Standard Occupational Classification (SOC) to assess occupational contributions to sarcoidosis risk.

A case control etiologic study of sarcoidosis: environmental and occupational risk factors.

Past research suggests that environmental factors may be associated with sarcoidosis risk. We conducted a case control study to test a priori hypotheses that environmental and occupational exposures are associated with sarcoidosis. Ten centers recruited 706 newly diagnosed patients with sarcoidosis and an equal number of age-, race-, and sex-matched control subjects.

Two year prognosis of sarcoidosis: the ACCESS experience.

A cohort of 215 sarcoidosis patients from the ACCESS study underwent a clinical evaluation at study enrollment and two years later. Approximately 80% of subjects had an improved or stable FVC, FEV1, chest radiograph determined by Scadding stage, and dyspnea scale. African-Americans had less improvement in FVC than Caucasians (p = 0.

The diagnostic pathway to sarcoidosis.

Purpose: To examine the time from the first physician visit to the diagnosis of sarcoidosis.

Hypotheses: The time required to diagnose sarcoidosis is dependent on the initial symptoms, socioeconomic status, referral to a specialist, race, and severity of pulmonary involvement.

Methods: Patients were recruited from the Case Control Etiology of Sarcoidosis Study (ACCESS) and had biopsy-confirmed sarcoidosis.